MEDICARE: BRIAN J DEVOE DDS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	D11548	MN

General Provider Information

NPI Number	:	1699000869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN J DEVOE DDS PA

Provider Business Mailing Address
First Line	:	700 VILLAGE CENTER DR STE 140
Second Line	:
City	:	NORTH OAKS
State	:	MN
Zip	:	55127-3020
Country	:	US
Telephone Number	:	651-490-3155
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 VILLAGE CENTER DR STE 140
Second Line	:
City	:	NORTH OAKS
State	:	MN
Zip	:	55127-3020
Country	:	US
Telephone Number	:	651-490-3155
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	MR. BRIAN JOHN DEVOE
Credential	:	DDS PA
Telephone Number	:	651-490-3155

Provider Enumeration Date	:	10/06/2009
Last Update Date	:	04/03/2024

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